Co-designing Integrated Service Delivery for the Irish Health Service

The Health Service Executive (HSE) Health Regions Programme Team established an Integrated Service Delivery (ISD) Workstream group to progress design of an ISD model for the Irish healthcare system and to propose a preferred set of regional and local organisational structural arrangements to underpin, enable and support the provision of integrated care. The output of this work is for patients and users of health and social care services, service providers both HSE and partner agencies and the population as a whole. Following thorough stakeholder mapping and analysis, an ISD Workstream group was established, consisting of 94 individuals, representing a broad range of voices with influence and interest in the Irish health service, from within and outside the HSE. Stakeholder planning ensured representation from across health and social care services including patients/service users, academics, multi-disciplinary healthcare staff and managers, and policymakers. A range of services including community, hospital, HSE, and non-HSE partner agencies were included from national services and from each of the six geographical areas that will become the Health Regions. This process was led by the HSE Health Regions Programme team under the governance of the Health Regions Programme Governance fora. A comprehensive engagement process was developed underpinned by:- Principles of co-production The Health Services Change Guide Framework Design Principles for Government in Ireland. A thorough review of international integrated care models and literature informed the development of ISD design principles. Employing a co-design approach, the Programme Team conducted structured discussions, workshops, and semi structured interviews from May to November 2023. Engagements with members of the ISD Workstream Group were tailored to acquire the necessary outputs. This engagement process included 3 full workstream group events, 6 online engagements with 4 patient partners/service users, 31 in-depth interviews with 23 subject matter experts, 4 design workshops with 39 clinical leaders, operational managers and policy makers, and one multi-criteria analysis appraisal with 38 appraisers. The process yielded four high-level design options, presented to Health Regions Programme governance groups for consideration and decision making. The outcome reflects alignment with Sláintecare reform, the Health Regions Implementation Plan, and IFIC Principles of Integrated Care, showcasing a comprehensive and participatory approach to healthcare transformation. This collaborative process fortified relationships between key stakeholders and ISD design team and laid robust groundwork for detailed design and implementation, ultimately culminating in the identification of a preferred model for ISD which includes organisational arrangements to underpin, enable and support the provision of integrated care. Engaging early and consistently fosters investment and shared purpose. Mobilising support through engagement is crucial for building relationships and is essential to co-design. Sharing power from interactions stimulates diverse viewpoints and encourages responsibility and readiness for change. Developing informed strategies for engaging priority group’s demands focus and planning. The IFIC 9 pillars offer a clear framework to discuss and promote understanding, ensuring alignment with integrated care recommendations during the design process. Detailed design of the preferred model for ISD and implementation due to commence from June 2024